Basic Information
| Provider Information | |||||||||
| NPI: | 1942762737 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMARGO | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 611 ROUTE 46 WEST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HASBROUCK HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012658200 | ||||||||
| FaxNumber: | 2014784185 | ||||||||
| Practice Location | |||||||||
| Address1: | 611 ROUTE 46 WEST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HASBROUCK HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012658200 | ||||||||
| FaxNumber: | 2014784185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2019 | ||||||||
| LastUpdateDate: | 04/02/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 37AC00464400 | NJ | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.